Determinants of poststroke depression and its impact on functional outcomes: A hospital-based study in Nepal

Poststroke depression (PSD) is a common yet underrecognized neuropsychiatric condition that significantly affects the functional and psychosocial outcomes of stroke survivors. The etiology of PSD is complex and influenced by a combination of sociodemographic, clinical, and psychosocial factors. This cross-sectional descriptive study was conducted in the Neuromedicine Department of Bir Hospital to assess the prevalence of PSD and its association with factors such as functional independence and perceived social support. A total of 62 stroke patients with Mini-Mental State Examination scores >18 were included. Depression screening was initially performed using the Patient Health Questionnaire-9, and diagnosis was confirmed using the Tenth Revision of the International Classification of Diseases - Diagnostic Criteria for Research. Severity of depression was measured with the Hamilton Depression Rating Scale, while functional independence was assessed using the Barthel Index and perceived social support was measured using the Multidimensional Scale of Perceived Social Support. Among the participants, 38.7% were male and 61.3% were female, with the majority aged between 55 to 64 years, illiterate, and from low socioeconomic backgrounds. Overall, 43.5% (n = 27) of the patients were diagnosed with PSD. Of these, 55.6% were female and 44.4% male. Depression was observed in 40.8% of patients with ischemic stroke and 53.9% of those with hemorrhagic stroke. PSD was more prevalent in patients with left-sided lesions (56.7%) compared to right-sided lesions (31.2%). The condition was most common in those more than 5 years poststroke. Assessment of functional independence revealed that 41.5% of PSD patients had mild dependence in activities of daily living, while 55.5% had moderate dependence. Notably, only 3.2% of those with high perceived social support experienced depression. The findings emphasize the importance of early detection of PSD and the potential protective role of social support in mitigating its development among stroke survivors.